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Observational Study
. 2016 Sep;120(3):428-433.
doi: 10.1016/j.radonc.2016.03.011. Epub 2016 Apr 29.

Image guided brachytherapy in locally advanced cervical cancer: Improved pelvic control and survival in RetroEMBRACE, a multicenter cohort study

Alina Sturdza  1 , Richard Pötter  2 , Lars Ulrik Fokdal  3 , Christine Haie-Meder  4 , Li Tee Tan  5 , Renaud Mazeron  4 , Primoz Petric  6 , Barbara Šegedin  6 , Ina Maria Jurgenliemk-Schulz  7 , Christel Nomden  7 , Charles Gillham  8 , Orla McArdle  8 , Erik Van Limbergen  9 , Hilde Janssen  9 , Peter Hoskin  10 , Gerry Lowe  10 , Ekkasit Tharavichitkul  11 , Elena Villafranca  12 , Umesh Mahantshetty  13 , Petra Georg  1 , Kathrin Kirchheiner  1 , Christian Kirisits  1 , Kari Tanderup  3 , Jacob Christian Lindegaard  3
Affiliations
Observational Study

Image guided brachytherapy in locally advanced cervical cancer: Improved pelvic control and survival in RetroEMBRACE, a multicenter cohort study

Alina Sturdza et al. Radiother Oncol. 2016 Sep.

Abstract

Purpose: Image guided brachytherapy (IGBT) for locally advanced cervical cancer allows dose escalation to the high-risk clinical target volume (HRCTV) while sparing organs at risk (OAR). This is the first comprehensive report on clinical outcome in a large multi-institutional cohort.

Patients and methods: From twelve centres 731 patients, treated with definitive EBRT±concurrent chemotherapy followed by IGBT, were analysed. Kaplan-Meier estimates at 3/5years were calculated for local control (LC, primary endpoint), pelvic control (PC), overall survival (OS), cancer specific survival (CSS). In 610 patients, G3-4 late toxicity (CTCAEv3.0) was reported.

Results: Median follow up was 43months, percent of patients per FIGO stage IA/IB/IIA 22.8%, IIB 50.4%, IIIA-IVB 26.8%. 84.8% had squamous cell carcinomas; 40.5% lymph node involvement. Mean EBRT dose was 46±2.5Gy; 77.4% received concurrent chemotherapy. Mean D90 HRCTV was 87±15Gy (EQD210), mean D2cc was: bladder 81±22Gy, rectum 64±9Gy, sigmoid 66±10Gy and bowel 64±9Gy (all EQD23). The 3/5-year actuarial LC, PC, CSS, OS were 91%/89%, 87%/84%, 79%/73%, 74%/65%. Actuarial LC at 3/5years for IB, IIB, IIIB was 98%/98%, 93%/91%, 79%/75%. Actuarial PC at 3/5years for IB, IIB, IIIB was 96%/96%, 89%/87%, 73%/67%. Actuarial 5-year G3-G5 morbidity was 5%, 7%, 5% for bladder, gastrointestinal tract, vagina.

Conclusion: IGBT combined with radio-chemotherapy leads to excellent LC (91%), PC (87%), OS (74%), CSS (79%) with limited severe morbidity.

Keywords: Image guided brachytherapy; Locally advanced cervical cancer; Outcome.

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